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PubMed1993

Successful treatment of life-threatening ventricular tachycardia with high-dose propranolol under extracorporeal life support and intraaortic balloon pumping.

The use of propranolol is generally contraindicated in patients with congestive heart failure. However, we successfully used a continuous high-dose infusion of propranolol, in combination with the use of extracorporeal life support (ECLS) and intra-aortic balloon pumping (IABP), to treat refractory life-threatening ventricular tachycardia in a patient with postoperative congestive heart failure. The early combined use of ECLS and IABP before irreversible myocardial damage contributed to the successful outcome.

Combined Modality Therapy↗
PubMed2004

A discriminative study of health-related quality of life assessment in HIV-1-infected persons living in Japan using the Multidimensional Quality of Life Questionnaire for persons with HIV/AIDS.

The aim of this study is to evaluate the discriminative properties of the Multidimensional Quality of Life Questionnaire for HIV infection (MQoL-HIV) and to determine those factors contributing to the health-related quality of life (HRQoL) of HIV-1 infected persons living in Japan. The MQoL-HIV, the Nottingham Health Profile (NHP) as a generic instrument, and the Center for Epidemiologic Studies-Depression Scale (CES-D) as a psychological measure were administered in 375 patients as a multiple-centre study. The score distribution of the MQoL-HIV showed a unimodal distribution. The Cronbach's alpha coefficient scored more than 0.7 in seven out of 10 domains, but was low in both the physical functioning and sexual functioning domains. There was a strong correlation between the CES-D and MQoL-HIV index scores (R-0.73). Relatively high coefficient values were found between psychiatric and nervous symptoms and the index score (R=-0.60). In total, the MQoL-HIV may possess discriminative properties.

Adult↗
PubMed2001

[Recent trends in mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) attributable to tobacco in Japan].

To assess recent trends in mortality and disease burden from tobacco in Japan, the present study estimated the number of deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) attributable to tobacco for the years 1985 and 1995. Since smoking prevalence is a very poor measure of population exposure to tobacco, this study employed an alternative measure of the attributable fractions based on excess lung cancer mortality. It is suggested that there was a significant increase in both the absolute numbers and age-standardized rates of tobacco-attributed mortality and disease burden over the decade, in particular from lung cancer and chronic obstructive pulmonary disease. In 1995, tobacco already accounted for 12% of total mortality, 16% of total male mortality and 7% of total female mortality. The burden of disease attributable to tobacco amounted to 10% of the total YLLs and 7% of total DALYs, suggesting that tobacco is probably a single major risk factor of mortality and morbidity in Japan.

Adult↗
PubMed1999

Measuring quality of life in back patients: comparison of Health Status Questionnaire 2.0 and Quality of Life Inventory.

This paper is a reliability and validity test of the Health Status Questionnaire (HSQ) 2.0. In addition, the Quality of Life Inventory (QOLI) is compared with the HSQ 2.0 to assess concurrent validity. The study is unique because these instruments are assessed for the first time using a sample of chronic back patients. Practitioners will therefore now be able to evaluate important quality of life issues and treatment changes in this population. The HSQ 2.0 was generally found to be valid for these patients. However, two scale domains were not differentiated due to unique characteristics of spinal disease patients. The QOLI, due to the limitation of measuring only psychological well-being, did not measure problems specific to back patients.

Activities of Daily Living↗
PubMed1993

Decisions near the end of life: professional views on life-sustaining treatments.

OBJECTIVES: How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients' rights to forgo life-sustaining medical treatments and to receive adequate pain control? METHODS: We surveyed 687 physicians and 759 nurses in 5 hospitals. RESULTS: Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. CONCLUSIONS: In summary, many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments.

Attitude of Health Personnel↗
PubMed2001

Measuring quality of life in people with aphasia: the Stroke Specific Quality of Life Scale.

Assessing health related quality of life (HRQOL) in people with communication disabilities is a challenge in health related research. Materials used to assess HRQOL are often linguistically complex and their mode of administration usually does not facilitate people with communication disabilities to give their experiences. We are currently running a medium scale study (80 participants) which aims to explore the HRQOL of people with long-term aphasia and to assess the psychometric properties and the acceptability of the Stroke Specific Quality of Life Scale (SS-QOL) (Williams et al. 1999) as a single measure for the assessment of HRQOL in this population. Here the initial stages of modifying the SS-QOL for use with people with aphasia will be presented. We will concentrate on the process of making the scale communicatively accessible to people with aphasia and increasing its content validity with this population group.

Aphasia↗
PubMed2006

[Follow-up study on subjective quality of life for elderly persons with dementia using the Japanese version of Dementia Quality of Life Instrument (JDQoL)].

PURPOSE: There are few longitudinal studies on the subjective quality of life for elderly persons living in their own homes. The purpose of this study was to clarify the validity and reliability of the Japanese version of the Dementia Quality of Life Scale (JDQoL) used in a follow-up survey as part of a longitudinal study in Japan. METHODS: A baseline study was conducted from November 2002 to January 2003, and a year later a follow-up study was conducted from October 2003 to January 2004. The subjects included 72 (19 men and 53 women) elderly persons with dementia living in their own homes. Sixty-six were diagnosed with vascular dementia (VD) and 6 had senile dementia of Alzheimer's type (SDAT). The follow-up study included 60 subjects (VD: 56 and SDAT: 4); _10 of the original subjects were hospitalized, one died, and one was unable to attend daycare because of deterioration. Evaluation was conducted using the JDQoL, MiniMental State Examination (MMSE), and Geriatric Depression Scale (GDS). RESULTS: For the MMSE, the average score of the subjects in the follow-up study was 20.87 (+/- 4.80), which was significantly higher than the score of subjects that were excluded from the follow-up study (17.82 +/- 5.65). At baseline, reliability coefficient was demonstrated by Cronbach's alpha value of 0.744 approximately 0.886. One year later, Cronbach's alpha was 0.723 approximately 0.872. Among the subjects in the follow-up study, MMSE scores decreased significantly compared with the baseline study. In the subscales of the JDQoL, Negative Feelings (reversal item) significantly improved and Feeling of Belonging significantly decreased after one year (p<0.05). Each subscale of the JDQoL had significant correlation with the GDS at baseline and follow-up. Scores on the GDS at baseline had significant correlation with Self Esteem, Positive Feelings, Negative Feelings, and Feeling of Belonging of the JDQoL at follow-up (0.320 to 0.504; p<0.05). CONCLUSION: We demonstrated that the reliability and validity of the JDQoL was comparable to the English version of DQoL. Subjective QOL did not decline for all sub-scales, Negative Feelings in the JDQoL significantly improved compared to baseline.

Aged↗
PubMed1998

Posttransplant quality of life: a decade of descriptive studies leading to practice interventions. Posttransplant Quality of Life Intervention Study Group.

Following 10 years of descriptive quality-of-life studies, an innovative approach to outpatient care has been developed to decrease adverse events, increase employment, and enhance social support among renal transplant recipients. These 3 variables were found in the authors' previous studies to be predictive of increased quality of life following transplantation. With funding from the National Institute of Nursing Research, a multidisciplinary team has been assembled to implement the interventions identified. This article reviews the previous work that led to the development of the intervention study and demonstrates how research can guide practice.

Adaptation, Psychological↗
PubMed2001

Quality of life one year following bone marrow transplantation: psychometric evaluation of the quality of life in bone marrow transplant survivors tool.

PURPOSE/OBJECTIVES: To examine a comprehensive view of quality of life (QOL) post-bone marrow transplant (post-BMT) and to evaluate the psychometric properties of an instrument designed to measure QOL in this population. DESIGN: Cross-sectional, descriptive, mailed survey. SETTING: A large, major BMT referral center for central, eastern, and southern Kentucky. SAMPLE: 41 BMT survivors with an age range of 18-71 years who were an average of 30 months post-BMT. METHODS: Seven mailed questionnaires, including an investigator-developed demographic questionnaire and the Quality of Life in Bone Marrow Transplant Survivors Tool (QOL-BMT-ST). MAIN RESEARCH VARIABLES: QOL, BMT treatment, sexual activities, employment, and uncertainty. FINDINGS: Global QOL was good (x = 6.4 on a 0-10 scale). Subjects experienced several long-term areas of concern: physical strength, sexual activities, fear of cancer recurrence, fear of developing a secondary cancer, unemployment, family distress, and uncertainty toward the future. Psychometric testing of the QOL-BMT-ST revealed adequate to excellent reliability and validity. CONCLUSIONS: Most BMT survivors reported few long-term disruptions and above average QOL. The QOL-BMT-ST has a promising utility in clinical trials. IMPLICATIONS FOR NURSING PRACTICE: Individually structured pre- and post-BMT assessment of physical, psychosocial, and spiritual functioning is significant in identifying vulnerable patients and treating them accordingly.

Adaptation, Psychological↗
PubMed2002

[Impact of the positive appraisal of care on quality of life, purpose in life, and will to continue care among Japanese family caregivers of older adults: analysis by kinship type].

PURPOSE: The impact of positive appraisal of care (PAC) on the caregiver's quality of life (QL), sense of purpose in life (sense of ikigai) and will to continue care was examined. METHODS: Data were collected from 322 Japanese family caregivers of older adults who were using visiting nursing services through 21 facilities in the Tokyo metropolitan area, and the prefectures of Shizuoka, Mie and Okinawa. RESULTS: The data were grouped by kinship type (husband or son, wife, daughter or daughter-in-law) and analyzed separately. From the multiple regression and logistic regression analyses, the following results were derived: 1) The PAC was not related to the physical QL regardless of the relationship type; 2) The relationship depended upon the relationship type: only the PAC was related to the mental QL among husband and son caregivers, both the PAC and the negative appraisal of care (NAC) were important among wives, only the NAC among daughters, and none of them among daughters-in-law; 3) Both the PAC and NAC were related to the sense of ikigai in all caregiver types except among husband and son caregivers, which showed no relationship between the NAC and sense of ikigai; 4) Both the PAC and NAC were related to will to continue care among son and husband caregivers, whereas only the PAC was among wives and daughters-in-law. Only the NAC was related among daughters. However, the difference across kinship type seems minimal for will to continue care. CONCLUSIONS: Understanding the PAC among family caregivers may be important in order to better assist them to improve their mental QL or sense of ikigai as well as to predict their continuation of caregiving at home. The impact of PAC varies depending on the kinship type, and it should be assessed separately with reference to this pariable to develop plans for appropriate assistance.

Aged↗
PubMed2004

Maintaining life-support and non-life-support equipment. What do JCAHO's new requirements mean?

As part of its new "Shared Visions--New Pathways" initiative, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited healthcare facilities to demonstrate that life-support equipment receives a high priority in their equipment-maintenance programs. JCAHO has also revised its overall accreditation scoring system. Some of our member hospitals have asked ECRI for advice on how to deal with these changes. JCAHO's intent, as we understand it, is not to impose burdensome new requirements on hospitals, but simply to ensure that life-support equipment receives the necessary equipment-maintenance priority. We believe that any facility that has been meeting JCAHO's requirements up to now won't need to significantly change its equipment-management program, though it will need to revise its documentation procedures. In this article, we describe the changes to JCAHO's requirements and outline the steps that hospitals need to take to meet the requirements--as well as the steps they don't need to take.

Accreditation↗
PubMed2004

Psychometric validation of the French version of the quality of life in epilepsy inventory (QOLIE-31): comparison with a generic health-related quality of life questionnaire.

A psychometric evaluation of a French transcultural version of the quality of life in epilepsy inventory-31 (QOLIE-31) was carried out. QOLIE-31 was compared to a generic health-related quality of life questionnaire, the Nottingham health profile (NHP). The psychometric properties of QOLIE-31, assessed in 190 adults with epilepsy, included: acceptability, test-retest reliability and validity (multi-trait analysis including internal consistency and item-to-scale correlations, construct validity using factor analysis, discriminative validity using relationship with disease characteristics, treatment effects, divergent and convergent validity using correlations with NHP scores). Both acceptability and reproducibility were good and internal consistency was high (Cronbach's alpha coefficient = 0.86). Factor analysis with varimax rotation identified seven factors with eigenvalues > 1, with two factors, related to cognitive function and mood, accounting for 46.5% of the variance. However, goodness of fit indices revealed that a model with four factors best fitted the data. The first factor corresponds to a generic mental dimension, the second is equivalent to the cognitive functioning dimension, the third to medication effects including social functioning, and the fourth to seizure worry. Discriminative validity was good for seizure control and treatment tolerability. High correlations between QOLIE-31 and pertinent NHP scales (emotional reactions, energy and social isolation) were observed. The French version of QOLIE-31 thus meets established psychometric criteria for reliability and validity.

Activities of Daily Living↗
PubMed2006

[Prehospital life support in trauma patients: basic or advanced trauma life support].

The controversy between Advanced Trauma Life Support (ATLS) and Basic Life Support (BLS) in the prehospital care of trauma patients has not been resolved yet. The purpose of this study was to examine the literature with respect to the type of prehospital care applied to the trauma patients. A total of 76 papers on ATLS and/or BLS for trauma were reviewed regarding the variables such as intravenous catheter application, prehospital fluid resuscitation, transport time, intubation and mortality. As a conclusion, the data in the literature do not support the routine use of on-field ATLS in trauma patients. Prospective randomized trials comparing ATLS and BLS in prehospital management of trauma patients are needed to clarify this issue.

Advanced Cardiac Life Support↗
PubMed2006

Death in life and life in death: melancholy and the enlightenment.

This article, which deals with the 17th and 18th centuries, is concerned with the presence of death in the melancholiac's life as revealed in both the accounts written by sufferers themselves and medical works. It shows the exceptional place which melancholiacs consider themselves to occupy, compared to the rest of the living, as they inhabit the no-man's-land between life and death. The privileged status echoes the classical theme of the melancholic genius (Problem XXX). Although some, like George Cheyne or Samuel Johnson, denied the link, this cliché is nevertheless very present in the self-description of the melancholy. Suffering, which is always physical, is a sign of moral superiority.

Death↗
PubMed2006

Bringing the Life Needs Model to life: implementing a service delivery model for pediatric rehabilitation.

This article describes the use and utility of the Life Needs Model of Pediatric Service Delivery at a regional children's rehabilitation center. The model is a transdisciplinary, evidence-based model that guides pediatric service delivery to meet the long-range goals of community participation and quality of life for children and youth with disabilities. The article describes the use of the model as a tool to assist with the development of organizational culture, strategic and operational planning, the development of therapists' expertise, and the development of community partnerships. The model also has influenced human resources practices, community relations activities, and research. The model provides needed direction to service planners about the types of services that are important to provide in a geographical region, and fills a gap in outlining the nature of services that can be encompassed in pediatric rehabilitation.

Adolescent↗
PubMed2006

Quality of life in aphasia: Greek adaptation of the stroke and aphasia quality of life scale - 39 item (SAQOL-39).

AIM: Health-related quality of life (HRQL) measures are becoming increasingly popular in evaluating health care interventions and services. The stroke and aphasia quality of life scale-39 item (SAQOL-39) is an English questionnaire that measures HRQL in people with aphasia. There is currently no measure to assess the HRQL of Greek-speaking people with aphasia. This study began the cross-cultural adaptation of the SAQOL-39 into Greek, by translating and linguistically validating the instrument. METHODS: The Mapi approach to linguistic validation was followed. The SAQOL-39 was forward translated into Greek and back-translated into English. The pilot version was produced by comparing the forward and backward translations. The resulting instrument was then reviewed by an expert professional and pilot tested with a sample of 10 people with aphasia. RESULTS: Sixty-seven percent of back-translated items matched those in the original instrument. Only 20% of the items in the consensus version needed amendments for the pilot version. The pilot testing showed that the SAQOL-39 had good accessibility (no missing data), acceptability (maximum endorsement frequencies, MEF=or>70%; 9 out of 10 participants had no difficulty) and content validity (8 participants had nothing to add to the questionnaire). CONCLUSIONS: By employing the Mapi approach to linguistic validation, a close matching between the original and the Greek version of the SAQOL-39 was ensured. The Greek SAQOL-39 is accessible and acceptable to people with aphasia. Further research is needed on the psychometric properties of the Greek SAQOL-39 and on its appropriateness as a clinical outcome measure.

Aged↗
PubMed2006

[Unhealthy lifestyles during the life course: association with physical decline in late life].

This study aimed to examine the association between unhealthy lifestyle in young age, midlife and/or old age and physical decline in old age, and to examine the association between chronic exposure to an unhealthy lifestyle throughout life and physical decline in old age. The study sample included 1297 respondents of the Longitudinal Aging Study Amsterdam (LASA). Lifestyle in old age (55-85 y) was assessed at baseline, while lifestyle in young age (around 25 y) and midlife (around 40 y) were assessed retrospectively. Lifestyle factors included physical activity, body mass index (BMI), number of alcohol drinks per week and smoking. Physical decline was calculated as change in physical performance score between baseline and six-year follow-up. Of the lifestyle factors present in old age, a BMI of 25-29 vs. BMI <25 kg/m2 (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.1-2.2) and a BMI of > or =30 vs. BMI <25 kg/m2 (OR 1.8; 95% CI 1.2-2.7) were associated with physical decline in old age. Being physically inactive in old age was not significantly associated with an increased risk of physical decline, however, being physically inactive both in midlife and in old age increased the odds of physical decline in old age to 1.6 (95% CI 1.1-2.4) as compared to respondents who were physically inactive in midlife and physically active in old age. Being overweight in both age periods was associated with an OR of 1.5 (95% CI 1.1-2.2). These data suggest that overweight in old age, and chronic exposure to physical inactivity or overweight throughout life increases the risk of physical decline in old age. Therefore, physical activity and prevention of overweight at all ages should be stimulated to prevent physical decline in old age.

Adult↗
PubMed1990

A better life than before--quality of life in people with renal failure.

We take it for granted that one of the objectives of nursing is to improve patients' quality of life, but this is notoriously difficult to define. A surgery of renal patients revealed some surprising results of what they considered to constitute quality of life, with implications for the future of nursing care.

Humans↗